How common is insomnia in older adults, and what are the repercussions of chronic sleep problems?

Insomnia is very common among older adults, and is associated with adverse health outcomes, including cognitive and functional decline. It has been estimated that approximately 40-70% of older adults age 65 and older experience sleep problems, with about 20% experiencing severe sleep problems. Insomnia has multiple causes, but chronic health conditions such as diabetes, hypertension, cancer, and osteoarthritis are among the most common health problems associated with poor sleep. Another common cause of insomnia is depression. Furthermore, insomnia in older adults may exacerbate the severity of pre-existing health conditions, perhaps leading to costly health service use.

Who were your participants in this study?

The sample of our study consisted of middle-aged and older adults aged 50 years or older who participated in the longitudinal Health and Retirement Study. Individuals in our sample were assessed for insomnia symptoms in 2006, and their health service utilization was assessed two years later. At baseline, 55% of participants were women, 88% were non-Hispanic white, 59% had a diagnosis of hypertension, 38% had osteoarthritis, and 21 percent had diabetes. Twenty-four percent reported one insomnia symptom, and 18% reported two or more insomnia symptoms at baseline.

According to your research, what is the link between insomnia and the use of health care services in older adults?

We found that individuals reporting one insomnia symptom, as well as two or more insomnia symptoms at baseline, were more likely to use a number of health services two years later compared to those reporting no insomnia symptoms. This health service utilization included hospitalization, use of home healthcare services, and use of a nursing home. Surprisingly, we found this association was still statistically significant for hospitalization and use of any of the three health services after accounting for a number of common health conditions, and depression.

Our results suggest that insomnia is associated with greater use of costly health services, and that perhaps preventing, or at least clinically addressing insomnia symptoms, might minimize healthcare costs for middle-aged and older adults. Our results also suggest that the assessment and recognition of insomnia by clinicians might help identify individuals at greater risk of hospitalization and other costly services. Medical professionals might be able to target and provide more intensive preventive care to individuals reporting insomnia symptoms. Our study found that if the association between the experience of insomnia symptoms and health service use were in fact causal, we would expect to see a six to fourteen percent decrease in health service use. It should be noted that our findings are based on self-reported insomnia symptoms and health service utilization, which is subject to reporting and recall bias. Furthermore, we only examined any use of health services, and we did not assess the duration and frequency of use. Our findings need to be confirmed in other population-based studies of older adults, and more research is needed to examine this association using objective measures of sleep quality and measures that capture the intensity of health service use.

What are some ways to prevent and treat insomnia?

Very often, simple sleep hygiene measures such as reducing environmental stimuli at night, establishing bedtime routines, or avoiding day-time naps would be sufficient to address insomnia. Adequately addressing and managing chronic health conditions can also prevent the development of insomnia. If these measures do not improve sleep, behavioral therapy can be effective. In some cases, sleep medications may be used on a short-term basis. However, the use of sleep medications in older adults, if taken for a longer period of time, has been shown to lead to numerous adverse health outcomes, such as falls, hip fractures, and cognitive and functional impairment.

Mr. Christopher Kaufmann is a doctoral student in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health. His research interests are in the utilization of health services related to psychiatric disorders, as well as the use of prescription medications among older adults. Dr. Adam Spira is an Assistant Professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health. He studies the link between sleep disturbance and both cognitive and functional decline in older people. Together they are the authors of “Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study” in The Journals of Gerontology Series A, which is available to read for free for a limited time.

The Journals of Gerontology were the first journals on aging published in the United States. The tradition of excellence in these peer-reviewed scientific journals, established in 1946, continues today. The Journals of Gerontology, Series A publishes within its covers the Journal of Gerontology: Biological Sciences and the Journal of Gerontology: Medical Sciences.

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